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BJA Advance Access published online on July 24, 2007
British Journal of Anaesthesia, doi:10.1093/bja/aem199
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Continuous cardiac output during off-pump coronary artery bypass surgery: pulse-contour analyses vs pulmonary artery thermodilution

Per Steinar Halvorsen1,*, Andrej Sokolov1,3, Milada Cvancarova2, Per Kristian Hol1, Runar Lundblad4 and Tor Inge Tønnessen1,3,5

1 The Interventional Centre,
2 Department of Biostatistics
3 Department of Anaesthesiology
4 Department of Cardio-Thoracic Surgery, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway
5 Medical Faculty, University of Oslo, Oslo, Norway

* Corresponding author: The Interventional Centre, Rikshospitalet-Radiumhospitalet Medical Centre, NO-0027 Oslo, Norway. E-mail: per.steinar.halvorsen{at}rikshospitalet.no

Background: No gold standard method exists for monitoring continuous cardiac output (CO). In this study, the agreement between the two most frequently used methods, PiCCO pulse-contour analysis (PCCO) and STAT pulmonary artery thermodilution (STAT-CO), was assessed during multiple-vessel off-pump coronary artery bypass (OPCAB) surgery.

Methods: Thirty patients were enrolled in the study. Two time periods were defined during surgery; Period 1 included positioning of the heart and stabilizer device and Period 2 included the coronary occlusion. Measurements were obtained every minute during both periods. The agreement for the continuous CO and the change in CO ({Delta}CO) was estimated using the Bland–Altman method.

Results: Significant changes in mean arterial pressure ({Delta}MAP), central venous saturation, PCCO and STAT-CO were seen only during Period 1. {Delta}MAP correlated only with changes in PCCO, (P<0.001, r=0.60). The mean difference (2SD) between PCCO and STAT-CO ranged from –0.29 (1.82) to –0.71 (2.57) litre min–1, and the percentage error varied from 32 to 50%. For the CO measurements, the limits of agreements did not differ between Period 1 and Period 2. In contrast, for the {Delta}CO measurements, the limits of agreements were wider in Period 1 than in the more haemodynamically stable Period 2.

Conclusions: PCCO and STAT-CO show large discrepancies in CO during OPCAB surgery. Clinically acceptable agreement was seen only for trends in CO during haemodynamically stable periods.

Keywords: anaesthesia, cardiovascular; heart, cardiac output; measurement techniques, pulse-contour analysis; measurement techniques, thermodilution; surgery, coronary artery bypass


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